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Biomedical subjects

R J Bower

Publications and source records attributed to R J Bower.

At least 19 recordsLinked to original sources
PubMed1994

Mesenteric cysts in children.

BACKGROUND: Mesenteric cysts are uncommon benign abdominal masses. Approximately one third of patients with these lesions are children. METHODS: We reviewed our clinical records for the past 14 years (corresponding to the period of time in which ultrasonography and computed tomography became reliable methods for imaging pediatric patients) and found 10 patients with mesenteric cysts. RESULTS: We were surprised to discover that abdominal pain was a presenting complaint in all but one patient. Five of the patients had the findings of an acute surgical abdomen and were thought to have appendicitis. Two patients operated on for appendicitis were transferred to our hospital with the diagnosis of an abdominal mass. In each case the mass was a mesenteric cyst. Cyst distribution included the small-bowel mesentery in seven patients, the transverse mesocolon in two patients, and the right mesocolon in one patient. Six cases required concomitant bowel resection for the cyst removal, and all were cystic lymphangiomas. The resected specimens were described as cystic lymphangiomas in eight of the 10 cases. CONCLUSIONS: Mesenteric cysts should be considered as an origin for abdominal pain in children, particularly after exclusion of more common diagnoses. We have found ultrasonographic imaging to be a reliable method for the diagnosis of appendicitis in children and advocate its use as an initial imaging study in patients with an acute surgical abdomen and presumed appendicitis. If appendicitis is indicated unlikely by ultrasonogram, the examination can be extended to the remainder of the abdomen, which can reveal mesenteric cysts or other pathologic conditions.

Adolescent↗
PubMed1991

Optimum concentration of bupivacaine for combined caudal--general anesthesia in children.

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and intraoperative supplementation to general anesthesia for children. To determine the best concentration of bupivacaine for combined general-caudal anesthesia in children, 122 children aged 1-8 yr scheduled for outpatient inguinal herniorrhaphy were randomized to receive, in a double-blind fashion, caudal anesthesia with bupivacaine in one of six concentrations (0.125, 0.15, 0.175, 0.2, 0.225, or 0.25%). After incision, a programmed reduction in inspired halothane resulted, if tolerated by the subject, in an inspired halothane concentration of 0.5% 10 min after incision. End-tidal halothane concentration at hernia sac ligation for subjects receiving 0.175% bupivacaine (0.55 +/- 0.03%) was less than that for subjects receiving 0.15% bupivacaine (0.75 +/- 0.05%; P less than 0.05). Subjects receiving 0.175% bupivacaine also were discharged earlier from the postanesthesia care unit (PACU) (27 +/- 1 min) than were subjects receiving 0.15% bupivacaine (38 +/- 5 min; P = 0.05). Children receiving greater than or equal to 0.2% bupivacaine tended to complain more of leg weakness after surgery; however, the difference did not reach statistical significance (39 of 67 vs. 16 of 47; P = 0.057). The incidence of complaints of leg weakness and paresthesia was positively correlated with bupivacaine concentration (r = 0.706; P = 0.05). Subjects receiving 0.125% bupivacaine had higher pain scores on arrival to the PACU than did those receiving 0.2% bupivacaine (P = 0.05); there were no other differences in pain scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed1989

Management and follow-up of arterial thrombosis in the neonatal period.

The management and follow-up of 12 patients with major aortic thrombus formation occurring in the neonatal period between 1982 and 1987 are reported. Umbilical arterial catheters were inserted in 8 of the 12 patients before thrombus formation. Two patients had congenital thrombi. Hypertension, oliguria, hematuria, and elevated blood creatinine concentration were found at the time of diagnosis of the thrombus; nine of the patients had a patent ductus arteriosus. Supportive care was instituted in seven patients who were hemodynamically stable. Five of the patients had congestive heart failure, shock, or both, and were treated with surgical thrombectomy. Thrombolytic therapy was not used in either group. The five surgically treated patients and six of seven medically treated patients survived. Ultrasound examination suggested resolution of the thrombus in all survivors in 6 to 30 days. Sequelae from thrombus formation were present in all patients at the time of discharge and included hypertension in 9 of the 11 survivors and decreased renal function in six of them. Follow-up at 1 to 3 years revealed normal blood pressure, good growth, and good renal function in 10 of the survivors.

Anticoagulants↗
PubMed1988

Pyloric stenosis in the sick premature infant. Clinical and radiological findings.

The clinical and radiographic features of five sick premature infants with idiopathic hypertrophic pyloric stenosis are presented. Clinical features were nonspecific, the common findings being recurrent nonbilious emesis, persistent abdominal distention, and the inability to place a nasojejunal feeding tube through the pylorus. Plain abdominal radiographs demonstrated persistent gastric dilatation in four of the infants. Idiopathic hypertrophic pyloric stenosis should be considered in the differential diagnosis of premature infants with upper gastrointestinal tract symptoms.

Diagnosis, Differential↗
PubMed1985

Intestinal perforations by tube feedings in small infants: clinical and experimental studies.

The clinical and radiographic findings of eight low-birth-weight neonates (mean, 900 g) with perforations of the duodenum or jejunum associated with transpyloric feedings are reported. In four patients, the perforations occurred distal to any known tube position. In experimental studies in young rabbits, Silastic or polyvinyl chloride tubes were sewn in place with the tube tips in the proximal duodenum or proximal jejunum, and either normal oral feedings or feedings through the tubes were given. Perforations and gross or microscopic abnormalities of the bowel mucosa in the area of the tubes and beyond were more frequent in rabbits with tube feedings than those given normal oral feedings. It appears that tube feedings induce some degree of mucosal damage and contribute to bowel perforation.

Animals↗
PubMed1983

Surgical mortality and morbidity in extremely low-birth-weight infants.

Twenty extremely premature infants (birth weight, less than 1,100 g) underwent 49 surgical procedures for acquired conditions, including necrotizing enterocolitis, other forms of gastrointestinal perforation, gastroesophageal reflux, patent ductus arteriosus, and hydrocephalus. Few congenital anomalies requiring operation were encountered in this group. The overall survival rate was 58%. Using a computerized data base to compare surgical patients with a weight-matched group of nonsurgical patients, it was shown that survival was similar and that adverse prenatal and perinatal influences were equally distributed between both groups. Surgery per se did not adversely influence survival in extreme low-birth-weight infants, and surgical patients are not a preselected group of stronger infants.

Birth Weight↗
PubMed1983

Management of Hirschsprung's disease in the adolescent.

Occasionally Hirschsprung's disease is misdiagnosed until the patient reaches adolescence. The disease of these young people may present technical problems not encountered in the neonate. I describe three such patients, ages 10, 13, and 19 years, who were managed successfully by slightly different surgical methods.

Adolescent↗
PubMed1982

Appendectomy in childhood. Analysis of 105 negative explorations.

Laparotomy with a preoperative diagnosis of acute appendicitis disclosed a normal appendix in 105 children (22.1 percent). In less than half of these, another condition was found or later identified, which explained the symptoms leading to operation. Ovarian lesions, acute ileocolitis, and serositis were the most frequently identified abnormalities. Twelve patients (11 percent) underwent definitive procedures in addition to appendectomy. Among patients in whom no abnormality was identified at laparotomy, peritoneal cultures yielded a broad range of organisms in 42 percent of those who had cultures. This may represent a mild form of acute primary peritonitis and may explain the symptoms which were confused with acute appendicitis.

Adolescent↗
PubMed1982

Clinical and histologic indications for extensive pancreatic resection in nesidioblastosis.

Nine children with nesidioblastosis underwent pancreatic resection at St. Louis Children's Hospital. Four of these underwent 99 percent of near-total resection. Only one child required permanent insulin therapy postoperatively. Pathologic examination of the resected pancreases revealed a diffuse disturbance of the pancreatic architecture. Prolonged hypoglycemia can have devastating neurologic sequelae. Based on clinical experience and the pathologic demonstration of a diffuse process in the affected pancreas, it is advocated that near-total (99 percent) pancreatectomy is the primary procedure of choice for this disease.

Female↗
PubMed1982

Postoperative fetal circulation: POFC.

Active pulmonary vasoconstriction and subsequent right-to-left atrial and/or ductal shunting of venous blood may influence the course of many neonatal cardiorespiratory disorders. The term "persistent fetal circulation" has been applied to these infants. This report concerns the late occurrence of fetal circulation after major intraabdominal operative procedures in two neonates. The first patient was a full-term, 3.6-kg infant with a covered, large liver-containing omphalocele. Cyanosis, hypoxia, and a right-to-left shunt were present at birth, but were improved by 24 hr of life. Primary repair was delayed for 6 days, in the belief that fetal circulation was unlikely to recur. On day 7, primary fascial closure of the omphalocele was followed by severe hypoxia secondary to right-to-left shunt, documented to be due to postoperative fetal circulation (POFC). The second was a 1600-g premature infant who was well until noted to be lethargic on the fourth day of life. Radiologic findings of pneumoperitoneum led to laparotomy and closure of a spontaneous gastric perforation. Twenty-four hours later the patient developed severe hypoxia and a right-to-left shunt at the atrial level was documented with contrast echocardiogram, again supporting the diagnosis of POFC. Each patient survived and has a normal heart. Both patients responded to hyperventilation and/or tolazoline therapy. Contrast echocardiography was a helpful, noninvasive means of establishing the diagnosis. This diagnosis should be considered in postoperative neonates after more common cardiac and pulmonary causes of hypoxia are excluded.

Female↗
PubMed1982

Ileal dysgenesis in infants and children.

Ileal dysgenesis describes the segmental dilatation of the terminal ileum treated in seven patients presenting from birth to 15 yr. Manifestations included saccular segmental ileal dilatation adherent to the peritoneal surface of an omphalocele sac in two neonates, a radiographically delineated enterolith in a child studied for an unrelated disorder, and a syndrome including pallor, fatigue, and anemia in four children aged 10 to 15 yr. Literature review uncovered 11 similar patients to 38 yr of age. Other symptoms in that group included intestinal obstruction and recurrent abdominal pain. At laparotomy all patients were found to have segmental saccular or tubular dilatation of the terminal ileum. The dilated segments varied in length from 8 to 25 cm. Meckel's diverticula were present in two patients. Segmental resection and anastomosis was performed in all patients. No lumenal stenosis was present in any specimen to account for the dilatation. Previous reports have referred to this abnormality as "giant Meckel's diverticulum" or "segmental ileal dilatation." Evaluation of these 18 patients suggests that this entity is an intrinsic abnormality of ileal development at the morphologically active site of juncture with the yolk stalk.

Adolescent↗
PubMed1982

Ventilatory support and primary closure of gastroschisis.

Recent clinical reports suggest that the majority of neonates with gastroschisis are best managed with a silon pouch technique. Our results with primary closure and short-term ventilatory assistance show a survival rate equal to that of the silon pouch technique. In addition, multiple operations and the chances of complications related to the pouch are avoided. No complications relating to the ventilatory assistance were encountered. Better pediatric ventilators and improved pediatric respiratory management allow this technique to be used for gastroschisis now, whereas 10 years ago the complications ith neonatal ventilators may have outweighed the morbidity of the silon pouch.

Abdominal Muscles↗
PubMed1981

Controversial aspects of appendicitis management in children.

The areas of controversy in appendicitis management in children include antibiotic usage, drainage of the peritoneal cavity, and closure of contaminated incisions. Our results and bacteriologic data suggest that gentamicin sulfate and clindamycin phosphate should be routinely used in cases of suspected perforation, that only selective and limited use of drains is warranted, and that delayed primary closure should be used in all cases with perforation.

Adolescent↗
PubMed1981

Perforated stress ulcers in infants.

During a 5-yr period, 10 infants less than 1 yr of age developed gastroduodenal perforation during treatment for severe underlying illness. Brisk gastrointestinal hemorrhage preceded perforation in most patients. In contrast to stress ulceration in adults, infants appear to have a higher frequency of single ulcers, perforation, and duodenal (rather than gastric) location. The mortality of 40% in this group, and in those patients reported in the literature who have been treated since 1960, implies that effective preventive and therapeutic measures are not yet available and also emphasizes the serious nature of the underlying disorder.

Duodenal Ulcer↗